| NPI | 1326384199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NJ 40QA01610300) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 20336) |
| Enumeration Date | 2012-12-21 |
| Last Update Date | 2016-04-07 |